Institute of Facial Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

2001ASF0602 Issued in UT

Legal business name

INSTITUTE OF FACIAL SURGERY

Practice address

5929 Fashion Blvd
Murray, UT 84107-7364

Phone

(801) 261-3637

Fax

(801) 261-4096

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brent D Kennedy, M.D.

Title

Director

Phone

(801) 261-3637

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bruce F Gladwell, CRNA

  • Certified Registered Nurse Anesthetist
  • Salt Lake City, UT
  • NPI 1962511923
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265656227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5929 FASHION BLVD",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841077364",
            "telephone_number": "801-261-3637",
            "fax_number": "801-261-4096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5929 FASHION BLVD",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841077364",
            "telephone_number": "801-261-3637",
            "fax_number": "801-261-4096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "801-261-3637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "UT",
            "license": "2001ASF0602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2001ASF0602",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Murray, UT
• Providers in Murray, UT by specialty
• Ambulatory Surgical Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.